PubMed · 15043245
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Michele M Pelter, Mary G Adams. 2004. Nonischemic ST-segment elevation.. https://pubmed.ncbi.nlm.nih.gov/15043245/
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INTRODUCTION: Spontaneous rupture of the oesophagus, also called Boerhaave's syndrome, is rare. Since its clinical manifestations are non specific, it must be evoked when confronted the sudden onset of chest or upper abdominal pain. OBSERVATIONS: Two patients were admitted to the emergency department with severe chest pain associated with vomiting. The CT scan obtained rapidly, revealed the perforation of the oesophagus. Despite early surgical treatment, only one patient survived, the second died of infectious complications. COMMENTS: Boerhaave's syndrome is fatal unless promptly recognized and adequately treated. A CT scan of the chest is the procedure of choice demonstrating the rupture.
When evaluating patients with possible coronary artery disease, it is necessary to combine physiologic assessment (measurements of ischemia) with anatomic pathologic assessment (coronary angiography). Coronary angiography currently is the only way to assess the anatomic pathology of the coronary circulation with precision. When it is combined with ventriculography and tests for myocardial ischemia, one can make clinical decisions related to the significance of the coronary artery disease observed. Common sense really demands that coronary angiography is only indicated when the information derived from this diagnostic procedure will facilitate therapeutic decisions in the individual patient.
BACKGROUND: Patients with diabetes without clinically apparent coronary artery disease are at increased risk of cardiac death. The value of screening stress testing in these patients remains controversial. The goal of this study was to examine the yield of stress single-photon emission computed tomography (SPECT) in asymptomatic diabetic patients. METHODS: The results of stress SPECT in patients without prior myocardial infarction or coronary revascularization were compared in asymptomatic diabetics (n = 1738) versus symptomatic diabetic patients (n = 2998), asymptomatic nondiabetic patients (n = 6215), and symptomatic nondiabetic patients (n = 16,214). RESULTS: Abnormal scans were present in 58.6% of asymptomatic diabetic patients, approximately equal to the percentage in symptomatic diabetic (59.5%) (P = not significant) and higher than in asymptomatic nondiabetic (46.2%) (P <.001) and symptomatic nondiabetic (44.4%) (P <.001) patients. The breakdown of high-risk scans followed a similar pattern in the 4 patient subsets: asymptomatic diabetic, 19.7% versus symptomatic diabetic, 22.2% (P =.051); asymptomatic nondiabetic, 11.1% (P <.001); and symptomatic nondiabetic, 12.5% (P <.001). Patients with diabetes had more electrocardiographic and scan evidence for silent myocardial infarction versus those without diabetes. CONCLUSIONS: Asymptomatic diabetic patients have a high prevalence of both abnormal and high-risk SPECT scans. The finding that approximately 1 in 5 of these individuals has a high-risk scan suggests a potentially more widespread application of screening stress SPECT in asymptomatic diabetic patients to identify those with severe coronary artery disease.